4. Barriers and Facilitators to Patients Addressing Their Own Issues
Each patient brought with them aspects of their personality; family and socio-economic circumstances that could impact on their ability to work with the SOS service, address their issues, and accept and make the best use of the advice on services/activities available. That in turn affected the degree of progress they could make and sustain longer term.
4.1 Barriers to Addressing Issues
Anxiety was one of the main barriers to patients seeking and taking up offers of help. The idea of mixing with other people could bring on panic attacks and prevented some patients leaving the house. Low mood and lack of motivation meant that patients struggled to see a way forward out of their difficulties. Poor mobility and other physical limitations could result in reluctance to leave the house because of the effort involved, particularly if the patient was in pain as a result of physical issues. Lack of money and resources was another barrier, especially if the patient had to travel to appointments. The lack of encouragement of those around the patient could be enough, in concert with other factors, to prevent the patient making efforts to address their issues and/or seek help. Some patients lacked basic social skills to enable them to interact successfully with services whilst others had behavioural issues which had the same negative effect. Lack of time due to family/work commitments was a barrier, as was commuting distance to services providing help. Patients usually had multiple barriers, for example, lack of money, poor mobility, ongoing pain and lack of self-confidence/low mood. The more barriers, and the more entrenched the barriers were, the greater the difficulty in breaking the negative cycle. Appointments would be planned between the patient, the Link Worker and the receiving service/group to work around barriers:
- if mornings were difficult for some patients (e.g. due to the effects of medication) then the appointment would be planned for the afternoon
- when working with parents, appointments were set so as not to clash with the school run or other family duties
- where patients found it difficult to leave the house, local venues near their home were used if possible
The key facilitator was a supportive family who could provide a positive reason for a patient addressing their issues and practical help such as taking the patient to appointments. Being able to drive and having a car took away one of the potential barriers to action. Another important facilitator was the ability of the patient to listen and process information. Having an understanding employer took the stress out of having to ask for time off to attend appointments, and employers could just as easily be a barrier to progress if they were not supportive of their employee. As with barriers, facilitators tended to work in tandem, for example, ability to take things on board, alongside the patient being determined and motivated, and having good family support.
Email: Naureen Ahmad